Uremic Fetor - Causes, Diagnosis, and Treatment

What Is Uremic Fetor?

Uremic fetor, also called ammonia breath, is one of the possible results of chronic kidney disease. It also appears to have a metallic taste called dysgeusia. The taste and smell are developed due to a product called ammonia, a product produced by breakdown of urea. With the progression of chronic kidney disease, the kidneys are not able to remove waste products from the body efficiently. As a result, waste products, urea, and fluid accumulate inside the body. The body tries to push the excess urea through the breath. When the excess urea reacts with saliva, it forms ammonia and exits through the breath.

What Is Uremia?

Uremia is a condition that develops when toxins build up in the blood. It is associated with kidney function impairment that leads to the accumulation of waste products in the blood. Uremia means the presence of urine in the blood. It involves the entire body. It is most commonly associated with end-stage renal disease, chronic kidney disease, acute kidney injury, and kidney failure. It can cause serious complications like fluid accumulation, hormone and metabolic problems, and electrolyte imbalance. Medication, kidney transplant surgery, and dialysis are all forms of treatment. Uremia can cause major health issues or even death if it is not treated.

People with chronic kidney disease, high blood pressure, diabetes mellitus, glomerulonephritis, and polycystic kidney disease are at a greater risk of developing uremia. The symptoms include fatigue, muscle cramps, nausea, vomiting, itching, weight loss, and shortness of breath from fluid accumulation. Severe cases present with symptoms like uremic fetor (urine-like odor on breath and a metallic taste in mouth) and uremic frost (appearance of yellow to white crystals on the skin due to the urea in sweat). The complications associated with uremia include acidosis, high blood pressure, hyperkalemia, infertility, malnutrition, and pulmonary edema. Atherosclerosis, hypertension, valvular stenosis and insufficiency, chronic heart failure, and angina can all develop as a result of a buildup of metastatic calcification and uremic toxins associated with uremia and end-stage renal disease.Dialysis is the common treatment for uremia and kidney transplant if uremia is the result of end-stage renal failure. In a transplant, a donor kidney from a living or deceased donor replaces the failing kidney.

What Are the Factors Causing Uremic Fetor?

Uremic fetor has other causes aside from kidney disease, which include a temporary decrease in kidney function and other conditions unrelated to the decrease in kidney function. Some causes of uremic fetor are minor or temporary while others can require immediate medical intervention. The causes include-

• Urinary tract infections.

• Heavy alcohol use.

• Urinary blockages.

• Sinus infections.

• Dehydration.

• Sinus infections.

• Helicobacter pylori bacterial infections.

• Eating too much protein.

What Are the Symptoms of Uremic Fetor?

• Unpleasant metallic taste (dysgeusia).

• Anorexia.

• Abdominal pain.

• Gastrointestinal bleeding.

• Ammonia breathe.

• Nausea.

• Vomiting.

• Fatigue.

• Muscle weakness.

• Headache.

• Malaise.

• Restless legs.

• Polyneuritis (an inflammatory disease that causes peripheral nerve lesions).

• Mental status changes.

• Seizures.

• Muscle cramps.

• Coma.

• Yellow to white patches on the skin due to urea in sweat.

How to Diagnose Uremic Fetor?

1. Physical Examination - A physician performs a physical examination and evaluates the symptoms to diagnose the disease. Based on this, the physician also orders some lab tests and imaging tests for further diagnosis and treatment modality.

2. Lab Tests - It is used to monitor certain chemicals that are elevated in uremia including creatinine, and urea, estimation of overall kidney function using glomerular filtration rate formula, and various other biomarkers of kidney function.

3. Kidney Ultrasound - A kidney ultrasound is done to check the shape and size of the kidney and the presence of scarring. It also detects the presence of kidney blockages like kidney stones, or physical injuries to the kidney.

How to Manage Uremic Fetor?

Uremic fetor can be treated by diagnosing the underlying cause. It can still be present if the underlying cause is treated with dialysis.

Treatment of the Underlying Disease - Uremia is generally a result of chronic kidney disease and requires dialysis or kidney transplant with medications. Dialysis is an artificial filtration of blood to remove waste products from the body. Two different types of dialysis exist. In hemodialysis, blood is filtered outside of the body using a machine. The lining of the abdomen and a specific fluid are used in peritoneal dialysis to filter blood. A kidney transplant is a procedure in which a healthy kidney is placed in an ectopic position in the body, which then acts as a normal healthy kidney to filter out the waste products from the body. Renal transplantation is related to improvements in survival and quality of life and should be considered early (before one requires dialysis), as the average wait for transplantation is frequently higher than two to three years. Other than that, supplementation for anemia, calcium and vitamin D supplements, phosphorus binders taken with males, and prevention of bone loss medications need to be taken.

Various measures to overcome the ammonia breath include-

• Brush the teeth, tongue, and gums several times a day.

• Chew sugar-free gums.

• Floss every day.

• Use a mouthwash and carry it to use it multiple times a day.

• Avoid strong-smelling food stuff like onions and garlic.

• Drink the recommended amount of water.

• Quit smoking.

• Make regular visits to the dentist.

What Are the Other Oral Problems of Kidney Disease?

Uremic fetor is not the only oral sign of kidney disease. The other signs include dry mouth, bleeding, and weakness in the jaw bones and joints. In addition, the other symptoms experienced are tingling on the lips or tongue, as well as swollen salivary glands. Keep the mouth hydrated, and practice good oral hygiene in order to minimize the effects of these symptoms. Having strong teeth and gums will help in enjoying a variety of foods without pain or discomfort, protect from the bacteria that can cause sickness, and reduce the risk of inflammation to stay healthy.

Conclusion

Uremic fetor arises as a result of uremia (urine in the blood), which in turn is a result of kidney function impairment. Like any other disease, ammonia breath can cause some other body image issues that affect confidence. There are various causes of uremic fetor other than kidney disease, including heavy alcohol use, urinary blockages, urinary tract infections, bacterial infections, and dehydration. The diagnosis is made on physical examination based on symptoms, lab reports, and kidney ultrasound. Treatment modality includes removing the causative factor and treating the oral environment with good oral hygiene habits.